Treatment for Urinary Incontinence in Women Older Than 65 Years

Abstract

Importance Urinary incontinence (UI) is common among women older than 65 years and negatively affects quality of life. However, the prevalence of UI treatment and determinants of treatment are largely unknown. Objectives The aim of this study was to identify rates of UI treatment and factors associated with treatment in older women with self-reported UI. Study Design This is a retrospective cohort analysis of a data set linking UI symptoms from the Nurses’ Health Study to Medicare claims. We evaluated use of pharmacotherapy, noninvasive, and procedural treatments for UI within 1 year before symptom survey. For pharmacotherapy, we used multivariable logistic regression to estimate odds ratios (ORs) of UI treatment. Results Of the 67,587 Nurses’ Health Study respondents, 15,088 had linkage to Medicare, subscribed to part D, and answered UI questions. Of these, 8,332 (55.2%) women reported UI, and 10.9% with UI had a Medicare claim for treatment; pharmacotherapy represented 94.6% of all treatments. On regression analysis, women with more severe and longer-term UI had higher odds of treatment (severe vs slight UI: OR, 3.1; 95% confidence interval [CI], 2.2–4.3) (longer vs new UI: OR, 1.9; 95% CI, 1.5–2.3). Women with mixed (OR, 2.5; 95% CI, 1.9–3.2) or urgency UI (OR, 3.0; 95% CI, 2.2–3.9) had greater odds of treatment compared with women with stress UI. Conclusions We estimate that only approximately 1 in 9 older women with self-reported UI underwent treatment within the year before reporting symptoms, of which pharmacotherapy was the most common UI intervention, and women with more severe and longer duration of symptoms were most often treated.